Public Health, Trauma & Road Safety: A Holistic Approach to Partnership Working Matt Staton Road Safety Education Team Leader, Cambridgeshire County Council Rod Mackenzie Clinical Director, East of England Major Trauma Centre, Cambridge University Hospitals RSGB Conference 16 November 2016

Overview Road trauma from the health perspective Redeveloping the Road Safety Partnership Targeting Road Injury Prevention (TRIP)

East of England Trauma Network Trauma System East of England Trauma Network www.eoetraumanetwork.nhs.uk

East of England Trauma Network Trauma System East of England Trauma Network www.eoetraumanetwork.nhs.uk

Trauma Fatal injuries Injuries requiring hospitalisation or resulting in disability Injuries treated in emergency department setting Injuries treated in primary care setting Injuries that do not receive attention in a healthcare setting

Epidemiology Engineering Education (ETP) Enforcement Epidemiology

Trauma System Epidemiology All Trauma Network Hospitals Consistent injury severity scoring Case-mix analysis Comparative outcomes Injury severity score Survival rates Patient reported outcomes Hospital performance System performance

Trauma System Epidemiology Population based Multi-agency Injury Research Register (5 years) 100% case ascertainment Complete epidemiological description Mechanism Injury patterns Pre-hospital care Emergency care Outcomes (pre-hospital and in-hospital) Socio-demographic profile Cambridgeshire Trauma Audit and Research Project

Epidemiology Burden of Disease (Count of patients, 95% CI)1 Pre-hospital System Survive to hospital Admitted with significant injury (meeting UK TARN entry criteria) 2 Age-standardised population rate per 100,000 (95% CI) 3 999 Call 2623 4 Serious injury 55 (53-57) Survival to hospital 46 (42-48) Serious Injury 34 (32-36) Severe Injury (ISS >8) 22 (20-23) Major Trauma (ISS > 15) 12 (11-13) Cambridgeshire Trauma and Research Project See www.tarn.ac.uk Directly age-standardised rate per 100,000 resident population with 95% confidence interval Based on estimate from Ambulance Service related to 999 call burden for trauma related AMPDS codes (150000/year)

Epidemiology 12 (11 to 13 ) 22 (20 to 23 ) 34 (32 to 36) EoE ITSPB 20 April 2010 Epidemiology Major Trauma ISS > 15 ‘Severe’ Injury ISS > 8 TARN entry criteria 12 (11 to 13 ) 22 (20 to 23 ) 34 (32 to 36) Age-standardised population rate per 100,000 (95% CI) R Mackenzie 10

Epidemiology Road traffic collisions remain the commonest cause of severe injury or life threatening major trauma

Do not meet entry criteria CTARP Data 39,763 STATS 19 Persons ‘injured’ 2,850 ONS Registered deaths 3,307 PHEMS Attended patients 3,383 TARN Submitted cases 254 Pre-hospital deaths 983 Survivors to hospital 38,526 Do not meet entry criteria 1,237 Meet entry criteria 2,020 1,363 2,682 625 186 439 2,464 261 123 384 329 1,685 150 In-hospital deaths Entry criteria: Kinetic injury event within the geographical County of Cambridgeshire between 2000 and 2004 and resulting in a pre-hospital trauma death (with injuries which would have met TARN injury criteria) or survival to hospital with admission that met TARN 07 entry criteria Cambridgeshire Trauma Audit and Research Project

CTARP Data Pre-hospital Deaths - 329 ONS STATS19 PHEMS (261) STATS19 (254) PHEMS (186) Entry criteria: Kinetic injury event within the geographical County of Cambridgeshire between 2000 and 2004 and resulting in a pre-hospital trauma death (with injuries which would have met TARN injury criteria) or survival to hospital with admission that met TARN 07 entry criteria Cambridgeshire Trauma Audit and Research Project

CTARP Data Survivors to hospital - 1685 Cambridgeshire Trauma Audit ONS (123) 35 21 1 2 20 PHEMS (439) 21 TARN (1363) 15 8 1 592 50 271 386 85 177 STATS 19 (983) Entry criteria: Kinetic injury event within the geographical County of Cambridgeshire between 2000 and 2004 and resulting in a pre-hospital trauma death (with injuries which would have met TARN injury criteria) or survival to hospital with admission that met TARN 07 entry criteria Cambridgeshire Trauma Audit and Research Project

CTARP ‘KSI’ Data 39,763 persons STATS19 persons (from 17,256 incidents) STATS19 persons Five years - 2000 to 2004 inclusive 15,897 uninjured and 1 unborn child excluded 23,865 persons 334 ‘killed’ 2924 ‘serious’ 20,594 ‘slight’ 1064 discharged from ED 254 STATS19 pre-hospital deaths (172 resident, 82 non-resident) 80 STATS19 in-hospital deaths (<30 days) (64 resident, 16 non-resident) 1860 1019 with LoS < 72 hrs and/or injuries which do not meet CTARP/TARN entry criteria 841 ‘serious’ + 2 in-hospital STATS19 death initially coded as serious and slight (both resident) 62 met TARN entry criteria, 1 of which was an in-hospital death + 61 patients coded as slight -1 of which is in-hospital death 336 ‘killed’ (238 resident / 98 non-resident)``````` 901 ‘severe’ TARN entry criteria (697 resident / 286 non-resident) Cambridgeshire Trauma Audit and Research Project 2083 ‘serious’ (1548 resident / 536 non-resident) 20,532 ‘slight’

CTARP ‘KSI’ Data Cambridgeshire Trauma Audit and Research Project

CTARP Responsibility Data All persons Cambridgeshire Trauma Audit and Research Project

CTARP Responsibility Data Responsible persons Cambridgeshire Trauma Audit and Research Project

CTARP Responsibility Data To blame (n=123) Whole group (n= 281) Significance (p) Median age (IQR) 35 (22-49) 34 (22-49) p=0.9 Mean Age (SD) 38 (20-58) 38 (19-57) Modal Age 30 18 P=0.02 Proportion male (%) 76 47 P=0.005 43% of those with ISS>15 following road traffic collisions were not responsible for the injury event Injury prevention strategies targeted according to the epidemiology of the injured may not effectively target those who cause injury events Cambridgeshire Trauma Audit and Research Project

Trauma System Lessons Learned Multi-agency data sharing improves understanding ‘Serious injury’ in STATS19 terms doesn’t necessarily constitute a ‘severe injury’ in trauma care or injury prevention terms Linking TARN and STATS19 data will provide the cheapest, quickest and most comprehensive understanding of road traffic related injury. Geo-demographic profiling, combined with culpability and injury severity analysis, might improve the targeting of ETP strategies. Cambridgeshire Trauma Audit and Research Project

Road Safety and Public Health KSIs per 100,000 population is a Public Health Outcomes Framework Indicator (1.10) NICE guidelines – PH29 strategies to prevent unintentional injuries among the under-15s PH8 Physical activity and the environment Road Safety is often a (perceived or actual) barrier to active travel Drug and alcohol safety Expertise in behaviour change interventions

Victim Support 64% of people bereaved by fatal road collisions suffer from depression 58% have general health problems 49% have sleeping problems 46% have anxiety attacks 41% have distressing nightmares 37% experience suicidal feelings 24% never work again

Redeveloping the Partnership LAs (CCC & PCC) Police Fire & Rescue Highways England East of England Trauma Network Road Victims Trust Cambridge University Hospitals Public Health The Cambridgeshire and Peterborough Road Safety Partnership (CPRSP) is a mature strategic partnership covering the geographical County of Cambridgeshire and the Unitary Authority of Peterborough. In addition to local authority, emergency services and Highways England representation, the partnership includes the East of England Trauma Network, the Road Victim’s Trust and the East of England Major Trauma Centre at Cambridge University Hospitals.

Redeveloping the Partnership “Our vision is to prevent all road deaths across Cambridgeshire and Peterborough and to significantly reduce the severity of injuries and the subsequent costs and social impacts from road traffic collisions.” Every death and life changing injury on Cambridgeshire and Peterborough’s roads or to a Cambridgeshire or Peterborough resident is one too many, and the social and economic burden of road casualties is felt much wider than just those immediately involved in the collision.

A new strategy

Trauma System Looking forward CTARP identified significant differences, in terms of demographics and marketing preferences, between profiles for injured road users and profiles for those who were uninjured but considered culpable for crashes. Existing prevention strategies, if targeted on injured road user profiles, may not be effectively targeted at high-risk or culpable road users.

Targeting Road Injury Prevention TRIP Project Targeting Road Injury Prevention Change the focus from those who are ‘KSI’ to those who are ‘at risk’ of causing death or serious injury, regardless of whether they themselves are harmed or not. PhD studentship hosted by Loughborough University in partnership with Addenbrookes Charitable Trust Grant funding from the Road Safety Trust £150k 3-5 year project £100k from Road Safety Trust Other funding from PCC and potentially other sources e.g. ADEPT

Targeting Road Injury Prevention TRIP Project Targeting Road Injury Prevention Question: Will prevention strategies based on the marketing preferences of culpable persons and high-risk road user profiles be more effective at reducing the number of road traffic related injuries and deaths than strategies based on casualty based data alone? £150k 3-5 year project £100k from Road Safety Trust Other funding from PCC and potentially other sources e.g. ADEPT

TRIP Project Utilise STATS19 and Police data, together with culpability analysis techniques, to identify: The severely injured Culpable persons (whether injured or uninjured) ‘High-risk’ road users who have not been involved in a crash (such as speeding, drink-driving, failure to wear a seatbelt and mobile phone use) £150k 3-5 year project £100k from Road Safety Trust Other funding from PCC and potentially other sources e.g. ADEPT

TRIP Project Undertake detailed epidemiological analysis to further define the geo-demographic profile (Mosaic Public Sector) and dominant marketing preferences of each of these groups. Identify postcode areas which match the over-represented geo-demographic profiles – these are people with similar geo-demographic profiles to the severely injured, culpable and high-risk road user groups. Develop and test a targeted ETP prevention strategy, designed around marketing preferences, for defined geographically bounded sub-sets of these groups. £150k 3-5 year project £100k from Road Safety Trust Other funding from PCC and potentially other sources e.g. ADEPT

Contact matt.staton@cambridgeshire.gov.uk roderick.mackenzie@addenbrookes.nhs.uk